Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation : Systematic Review and Individual Patient Data Meta-Analysis
(2022) In Journal of Clinical Medicine 11(24).- Abstract
Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively... (More)
Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.
(Less)
- author
- organization
- publishing date
- 2022-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiac surgery, central, ECMO, extracorporeal membrane oxygenation, peripheral, postcardiotomy
- in
- Journal of Clinical Medicine
- volume
- 11
- issue
- 24
- article number
- 7406
- publisher
- MDPI AG
- external identifiers
-
- pmid:36556021
- scopus:85144594959
- ISSN
- 2077-0383
- DOI
- 10.3390/jcm11247406
- language
- English
- LU publication?
- yes
- id
- 68d27632-d6e4-4527-915e-d40642fe6e35
- date added to LUP
- 2023-01-09 12:38:50
- date last changed
- 2024-04-18 07:42:22
@article{68d27632-d6e4-4527-915e-d40642fe6e35,
abstract = {{<p>Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I<sup>2</sup> 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.</p>}},
author = {{Biancari, Fausto and Kaserer, Alexander and Perrotti, Andrea and Ruggieri, Vito G. and Cho, Sung Min and Kang, Jin Kook and Dalén, Magnus and Welp, Henryk and Jónsson, Kristján and Ragnarsson, Sigurdur and Hernández Pérez, Francisco J. and Gatti, Giuseppe and Alkhamees, Khalid and Loforte, Antonio and Lechiancole, Andrea and Rosato, Stefano and Spadaccio, Cristiano and Pettinari, Matteo and Fiore, Antonio and Mäkikallio, Timo and Sahli, Sebastian D. and L’Acqua, Camilla and Arafat, Amr A. and Albabtain, Monirah A. and AlBarak, Mohammed M. and Laimoud, Mohamed and Djordjevic, Ilija and Krasivskyi, Ihor and Samalavicius, Robertas and Puodziukaite, Lina and Alonso-Fernandez-Gatta, Marta and Wilhelm, Markus J. and Mariscalco, Giovanni}},
issn = {{2077-0383}},
keywords = {{cardiac surgery; central; ECMO; extracorporeal membrane oxygenation; peripheral; postcardiotomy}},
language = {{eng}},
number = {{24}},
publisher = {{MDPI AG}},
series = {{Journal of Clinical Medicine}},
title = {{Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation : Systematic Review and Individual Patient Data Meta-Analysis}},
url = {{http://dx.doi.org/10.3390/jcm11247406}},
doi = {{10.3390/jcm11247406}},
volume = {{11}},
year = {{2022}},
}